From: the Crisis in Psychotherapy Practice Task Force of the NYS Psychological Association

The Crisis in Psychotherapy Practice Task Force (CPP) was formed in 2007 by Dr. Dianne Polowczyk while she was NYSPA President. Members of the Task Force are: Drs. George Northrup, Beverly Lawson, Jerry Grodin, Jamie Shiffner, Sharon Brennan and Dianne Polowczyk; Drs. Frank Goldberg and Barbara Fontana are co-chairs.

Many psychologists both in New York and across the country are in independent private practice providing psychotherapy services and want to continue to do so. Yet many of our colleagues are struggling to earn enough money to support their families and early career psychologists have the additional burden of student loan debt. We are all aware of the stagnant reimbursement rates over the last twenty-plus years and the increase in master degree level practitioners who also provide psychotherapy services. We believe psychologists are the best trained mental health professionals; consumers want and need our services but it becoming increasingly difficult for them to access care by a psychologist.

We support the vision of Dr. James Bray and others to expand the practice of psychology into other areas such as integrated care and prescription privileges. But we also think APA must make a heroic effort on behalf of the vast majority of psychologists, young and old, who pay the Practice Assessment and provide psychotherapy.

We have summarized below some of our concerns and recommendations.

We value the Practice Organization’s efforts to fight cuts in Medicare rates and have psychologists designated with equivalent status to physicians within Medicare. But, in our opinion, the compelling issues of psychologists in private psychotherapy practices are not being addressed at the level necessary to preserve our profession.

While we know that psychotherapy often helps people live happier and more functional lives, medication rather than psychotherapy is being used more frequently to alleviate mental health problems.

Many students enter doctoral programs in psychology because they want to provide psychotherapy. If graduates can’t earn a living in psychotherapy practice, admissions to these programs will eventually drop because of supply and demand. This will affect our academic colleagues.

Data we have collected indicate that both NYSPA and Division 42 members overwhelmingly chose fair reimbursement as the number one priority for APAPO in health care reform. In a NYSPA survey this year, 75.9% of the 673 respondents chose “reasonable compensation for psychotherapy in private practice” as the top priority for APA to address during health care reform discussions. In a Division 42 survey 71% chose compensation as the top priority and in a Tennessee Psychological Association survey 47% of 58 respondents also chose compensation as the top priority. (NYSPA survey results are attached)

In the same NYSPA survey psychologists were divided on the statement: “APA is making good use of the practice assessment that private practitioners pay in addition to regular dues.” Of 684 respondents, 30.2% disagreed or strongly disagree; 21.7% agreed or strongly agreed; 24.7% neutral; 23.7% no opinion.

A number of psychologists in private psychotherapy practice resigned from APA because they felt abandoned by APA and the PO; many others withheld the practice assessment for the same reason.

Our data indicate that NY psychologists received many calls from consumers who have contacted several psychologists in their plan’s network and cannot find a psychologist who is in the plan and accepting new patients. Again, consumer access to care by psychologists is negatively impacted. (see Phantom Panel Survey Results)

Recommendations to APA and/or the Practice Organization are as follows:

Launch a historic marketing campaign with the message that psychologists are the best trained mental health doctors, we provide psychotherapy based on science and research, our treatment is highly effective and in some cases more effective than medication.

Aggressively pursue reasonable compensation for psychologists as a top priority in health care reform discussions since it affects consumer access to treatment by the best trained mental health professionals.

Be a major player in health care reform and form strong alliances with other professional organizations to influence health care reform and fair compensation in all plans.

Allocate much more of the practice assessment to save psychotherapy practice from extinction.

We are most interested in the survival of psychotherapy practice and appreciate your assistance in this crisis. You can reach the co-chairs of the CPP Task Force or the President of NYSPA if you have any questions or would like to start a similar task force in your region or division.

Efforts to fully integrate psychological services into the broader health care system will fail unless the problem of fair compensation for such services is solved. Reimbursement for psychologists’ services under managed care has been declining in real dollars for at least the past 20 years. The financial viability of the independent practice of psychology has been devastated by this trend. Consumer access to psychologists in managed reimbursement environments continues to worsen, with declining numbers of contracted psychologists, and false claims by managed care about the numbers who remain. A for-profit, managed reimbursement financing system is fundamentally incompatible with the independent practice of psychology and unfettered access by the public to doctoral level psychological services. Organized psychology must acknowledge the damage caused to the provision of psychological health services by for-profit reimbursement schemes, utterly reject such an approach in any reformed system, and develop and implement a comprehensive set of actions to usher in a new health care delivery, financing and reimbursement system. Reimbursement trends and resulting limitations in the public’s access to psychologists are documented, and recommendations for roles, strategies and actions for our professional organizations are provided.

I spoke on a panel this weekend with Drs. Frank Goldberg and Barbara Fontana, members of the “Crisis in Psychotherapy Practice” group, at the New York State Psychological Association Annual Convention. The topic of my talk was “Reimbursement for Psychologists’ Services: Trends, Impact on Access, and Solutions.”

“What is a Practicing Psychologist” is being provided to the Summit’s invited guests.

WHAT IS A PRACTICING PSYCHOLOGIST?

Summary

A practicing psychologist is a doctorally-trained professional with the knowledge and skills to foster and sustain change in individuals, couples, families, organizations, and communities. A psychologist has expertise in human health, development, performance, problems, and most importantly, human behavior. This expertise is based on a large body of scientific evidence about individual behavior and systems change in the context of gender, age, race/ethnicity and culture.

Today, practicing psychologists work with other health care providers to design and deliver integrated care to provide comprehensive care for children, teens and adults across the life span. Psychologists are committed to improving access, quality, and value in healthcare; and promoting healthy lifestyles in the context of healthy relationships, workplaces, and communities.

We are committed to extending psychological science and service to improve the health and well being of the nation – we look forward to your ideas on how to move toward a future where psychological services better serve your needs.

WHAT IS A PRACTICING PSYCHOLOGIST?

A practicing psychologist is a doctorally-trained professional with the knowledge and skills to foster and sustain change in individuals, couples, families, organizations, and communities A psychologist has expertise in health, development, performance, problems, and most importantly, human behavior. This expertise is based on an extensive body of scientific evidence about individual behavior and systems change in the context of gender, age, race/ethnicity and culture.

Practicing psychologists have been associated with science and service since the beginnings of the profession. Lightner Witmer, who formed the first psychological clinic in 1896, highlighted the importance of evidence-based practice:

“The pure and the applied sciences advance in a single front. What retards the progress of one retards the progress of the other; what fosters one fosters the other.”

The expectation that professional psychologists be trained as both scientists and practitioners was adopted as policy by the American Psychological Association (APA) in 1947. Successive decades brought advances in services. Psychologists dramatically expanded their professional roles in response to the tremendous unmet mental health needs among WWII veterans. The 1960s saw many psychologists working in leadership roles to further the community mental health center movement, which ended the era of isolated mental hospitals and offered localized multidimensional care.

Today, community health centers offer similar opportunities for psychologists to work with other health care providers to design and deliver population-based, integrated care. The Freedom of Choice Act in the 1980s offered the public equal access to psychologsts and physicians for private sector mental health care. In this first decade of the 21st century, the parity of mental health and physical health has finally been recognized by Congress, thus paving the way for true integrated health care and improved access to services. During this same period, psychologists took on key internal and external consulting roles in leadership and talent management and in addressing the challenges of rapid organization change in the new global marketplace.

Psychology practice evolved in innovative ways that continue today in a range of public and private settings such as health centers and hospitals, schools, corporations, governmental agencies, the military, universities, and community organizations. Depending on their context, psychologists may:

* Use diagnostic and treatment skills to get to the root of a patient’s lack of adherence to medical treatments (e.g., medication, exercise, smoking cessation, physical therapy etc), due to emotional difficulties such as depression or personality problems, substance abuse issues, exposure to trauma, family problems or sociocultural differences and disparities.

* Work to improve partnerships and team functioning among health professionals, and among corporate professionals.

* Evaluate hospital, school, university, corporate and community program effectiveness, and produce clinical research to inform psychological interventions.

* Transport psychological science, services, research and consultation to urban and rural communities (e.g., to medical/health homes; long term care homes; schools, small businesses and corporations; community organizations such as Boys and Girls Clubs, YMCA, etc.).

* Provide interventions in business and corporate settings to reduce work place stress and violence; reduce costs related to illness, absenteeism, and poor performance; and improve productivity as well as worker satisfaction.

* Provide information to various media outlets in order to educate the public about psychological principles that improve mental and physical health.

*Promote individual and family strength, wellness, and resilience.

Now, amidst harsh economic realities and urgent social need, we join together with other professionals to support healthcare reform that provides comprehensive care for all children, teens and adults across the life span. Psychologists are committed to improving access, quality, and value in healthcare; and to promoting healthy lifestyles and advantageous social conditions in the context of healthy relationships, workplaces, and communities.

Consistent with recommendations from the Institute of Medicine (2001, 2004), we wish to collaborate with other disciplines in the interdisciplinary training of health professionals across specialties to ensure a work-force with the competencies to deliver high quality, comprehensive, integrated care. We wish to build partnerships to apply effective public health models that will reduce the burden of health, mental health and social concerns that negatively affect well being, healthcare utilization, and costs. We wish to work with businesses and corporations to enhance the health, well-being, and productivity of their employees.

Finally, we wish to lead and collaborate in the ongoing research and evaluation of outcomes in health care reform to ensure quality; effectiveness; safety; adherence; gender, cultural and geographic relevance; as well as improved patient health and satisfaction at reduced costs. We are committed to extending psychological science and service to improve the health and well being of the nation.

The Task Force sees necessary activities reaching in two directions: INTO APA/PO and TOWARD members to build cohesion and ability to act with a more unified and effective voice, and OUTWARD toward the public.

In the INTERNAL direction we heard last night, for example, about the “peer review” law for psychologists in New Jersey which limits the amount of information they are required to give to managed care and insurance companies, and about a law in Maryland which requires insurers to pay for out-of-network (mental health and other) care when a subscriber cannot obtain services without unreasonable delay or travel. While these are specific legislative successes, the larger point is that the individual psychologist-in-the-field, even though very linked in, may not know about what is happening in different states. APA/PO must develop effective methods to collect such events and disseminate the information systematically, and support replication in other states.

In terms of the outward perspective, we want the APA/PO to be allying with key other groups including other mental health and health professionals, and with consumer groups. Linking with other professionals will help work toward mutual agendas of increasing reimbursement and health care dollars. Linking with consumer groups will help give grass roots voice to lack of access to psychologists and mental health care.